Clinical classification of recurrent laryngeal nerve palsy
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PROVIDER: S-EPMC10570980 | biostudies-literature | 2023 Sep
REPOSITORIES: biostudies-literature
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Project description:We report a case of a female patient aged 46 years with a history of nodular goiter for which she had a subtotal thyroidectomy 31 years ago. She was referred to the emergency department of our hospital because of dyspnea and chest pain for 20 days, then developed cyanosis and edema of the head and upper extremities. Chest X-ray revealed tracheal repulsion. Cervical and thoracic computed tomography showed a giant solid and a cystic mass in the anterior mediastinum and bilateral pleural effusion. The neck ultrasound did not show any thyroid masses. An exploratory thoracotomy with extensive resection considering the anatomical relation of the mass and the adjacent structures was planned. Immediately after the operation, the patient developed airway complications that resolved in 7 days. The tumor was confirmed pathologically as nodular goiter. The overall outcome of the patient was positive; she is healthy after more than 12 months of follow-up. This report examines the approach to diagnosis and management of one of the most common surgical complication associated with substernal goiters.
| S-EPMC4360679 | biostudies-other
Project description:Revision anterior cervical spine surgery has a higher risk of recurrent laryngeal nerve palsy (RLNP). We describe a unique case of an isolated RLNP contralateral to the side of the surgical approach in a patient who underwent revision anterior cervical discectomy and fusion (ACDF) for cervical myelopathy, and in whom pre-operative laryngoscopic evaluation had excluded a pre-existing occult RLNP. Scarring around the recurrent laryngeal nerve at the previous surgical site may have rendered it less mobile, resulting in it being more susceptible to compression from an inflated endotracheal tube (ETT) cuff or traction from surgical retractors. This case illustrates that acute RLNP can rarely occur contralateral to the side of surgical approach in the setting of revision surgery. Surgeons performing revision ACDF can consider approaching from the same side as the index surgery or a posterior approach to reduce the risk of developing bilateral RLNP.
| S-EPMC8823468 | biostudies-literature
Project description:BackgroundPostoperative recurrent or permanent recurrent laryngeal nerve injury is one of the most serious complications in the field of thyroid surgery, in either benign or malignant thyroid disease, significantly affecting patients' quality of life. The importance of recurrent laryngeal nerve identification intraoperatively reduces the risk of injury. We report herein a young patient who underwent nerve monitoring in total thyroidectomy that led to recurrent laryngeal nerve injury.Case presentationWe report a 30-year-old Arab male patient who presented to our clinic with a longstanding thyroid swelling, which was reported as papillary thyroid carcinoma, and was scheduled for total thyroidectomy and lymph node dissection. Nerve monitoring was used to identify the recurrent laryngeal nerve, leading to recurrent laryngeal nerve nerve fatigability/paresis that was seen during the postoperative course.ConclusionVisual identification of the recurrent laryngeal nerve is the gold standard for nerve protection. We recommend the use of nerve monitoring as an adjunct in challenging cases but not in routine settings, as it does not decrease the incidence of injuries compared with visualization alone in our experience.
| S-EPMC11869657 | biostudies-literature
Project description:BackgroundThe Non-Recurrent Laryngeal Nerve (NRLN) is a rare embryologically-derived variant of the Recurrent Laryngeal Nerve (RLN). The presence of an NRLN significantly increases the risk of iatrogenic injury and operative complications. Our aim was to provide a comprehensive meta-analysis of the overall prevalence of the NRLN, its origin, and its association with an aberrant subclavian artery.MethodsThrough March 2016, a database search was performed of PubMed, CNKI, ScienceDirect, EMBASE, BIOSIS, SciELO, and Web of Science. The references in the included articles were also extensively searched. At least two reviewers judged eligibility and assessed and extracted articles. MetaXL was used for analysis, with all pooled prevalence rates calculated using a random effects model. Heterogeneity among the included studies was assessed using the Chi2 test and the I2 statistic.ResultsFifty-three studies (33,571 right RLNs) reported data on the prevalence of a right NRLN. The pooled prevalence estimate was 0.7% (95% CI [0.6-0.9]). The NRLN was found to originate from the vagus nerve at or above the laryngotracheal junction in 58.3% and below it in 41.7%. A right NRLN was associated with an aberrant subclavian artery in 86.7% of cases.ConclusionThe NRLN is a rare yet very clinically relevant structure for surgeons and is associated with increased risk of iatrogenic injury, most often leading to temporary or permanent vocal cord paralysis. A thorough understanding of the prevalence, origin, and associated pathologies is vital for preventing injuries and complications.
| S-EPMC5363258 | biostudies-literature
Project description:The pathophysiology of recurrent laryngeal nerve (RLN) transection injury is rare in that it is characteristically followed by a high degree of spontaneous reinnervation, with reinnervation of the laryngeal adductor complex (AC) preceding that of the abducting posterior cricoarytenoid (PCA) muscle. Here, we aim to elucidate the differentially expressed myogenic factors following RLN injury that may be at least partially responsible for the spontaneous reinnervation. F344 male rats underwent RLN injury or sham surgery (n=12). One week after RLN injury, larynges were harvested following euthanasia. mRNA was extracted from PCA and AC muscles bilaterally, and microarray analysis was performed using a full rat genome array. Microarray analysis of denervated AC and PCA muscles demonstrated dramatic differences in gene expression profiles, with 205 individual probes that were differentially expressed between the denervated AC and PCA muscles, and only 14 genes with similar expression patterns. The differential expression patterns of the AC and PCA suggest different mechanisms of reinnervation. The PCA showed the gene patterns of Wallerian degeneration, while the AC expressed the gene patterns of reinnervation by adjacent axonal sprouting. This finding may reveal important therapeutic targets applicable to RLN and other peripheral nerve injuries. Compare mRNA expression from injured tissue (recurrent laryngeal nerve transection injury) to normal tissue from two tissues laryngeal adductor complex and posterior cricoarytenoid muscles.
2016-07-01 | E-GEOD-72361 | biostudies-arrayexpress
Project description:BackgroundThe accuracy of clinical N staging of esophageal squamous cell carcinoma is suboptimal. As an important station of lymph node metastasis, station C201 (right recurrent laryngeal nerve nodes) has rarely been evaluated alone. We aimed to explore an effective way to evaluate the right recurrent laryngeal nerve nodes in thoracic esophageal squamous cell carcinoma.MethodsWe retrospectively analyzed 628 thoracic esophageal squamous cell carcinoma patients who underwent radical resection without neoadjuvant therapy from two Chinese cancer centers. The diameter of the short axis of the largest right recurrent laryngeal nerve node (DC201) was measured on contrast-enhanced multi-slice computed tomography (MSCT). Right recurrent laryngeal nerve nodes were examined by postoperative pathologic results. The receiver operating characteristic (ROC) curve was generated to assess the diagnostic capabilities of DC201 to determine the right recurrent laryngeal nerve nodes status.ResultsROC curve analysis revealed that the optimal cut-off point of DC201 was 6 mm, with an area under curve (AUC), sensitivity, specificity, and Youden index of 0.896, 71.9%, 88.8%, and 0.607 respectively. When the cut-off point of DC201 was set to 10 mm, sensitivity, specificity and the Youden index were 14.1%, 99.6% and 0.137 respectively. Among 128 patients with right recurrent laryngeal nerve node metastasis, 71 and 108 patients had the largest right recurrent laryngeal nerve node located above the suprasternal notch level and in the tracheoesophageal groove respectively.ConclusionsWhen DC201 ≥6.0 mm instead of DC201 ≥10 mm was used to dictate the right recurrent laryngeal nerve nodes metastasis, contrast-enhanced MSCT could evaluate the status of right recurrent laryngeal nerve nodes with high sensitivity and specificity. The largest right recurrent laryngeal nerve nodes were mainly located in the tracheoesophageal groove and/or above the suprasternal notch.
| S-EPMC7399419 | biostudies-literature
Project description:The pathophysiology of recurrent laryngeal nerve (RLN) transection injury is rare in that it is characteristically followed by a high degree of spontaneous reinnervation, with reinnervation of the laryngeal adductor complex (AC) preceding that of the abducting posterior cricoarytenoid (PCA) muscle. Here, we aim to elucidate the differentially expressed myogenic factors following RLN injury that may be at least partially responsible for the spontaneous reinnervation. F344 male rats underwent RLN injury or sham surgery (n=12). One week after RLN injury, larynges were harvested following euthanasia. mRNA was extracted from PCA and AC muscles bilaterally, and microarray analysis was performed using a full rat genome array. Microarray analysis of denervated AC and PCA muscles demonstrated dramatic differences in gene expression profiles, with 205 individual probes that were differentially expressed between the denervated AC and PCA muscles, and only 14 genes with similar expression patterns. The differential expression patterns of the AC and PCA suggest different mechanisms of reinnervation. The PCA showed the gene patterns of Wallerian degeneration, while the AC expressed the gene patterns of reinnervation by adjacent axonal sprouting. This finding may reveal important therapeutic targets applicable to RLN and other peripheral nerve injuries.
2016-07-01 | GSE72361 | GEO
Project description:ObjectivesRecurrent laryngeal nerve lymph node dissection (LND) has been incorporated into oesophagectomy for patients with oesophageal squamous cell carcinoma, but with uncertain oncological efficacy.MethodsThe data of patients with oesophageal squamous cell carcinoma, including who underwent upfront surgery (surgery group) and those who received neoadjuvant therapy followed by surgery (neoadjuvant chemoradiotherapy group), were retrospectively examined. The overall survival (OS) and disease-free survival (DFS) were compared between patients with and without recurrent laryngeal nerve LND.ResultsAmong the 312 patients, no significant differences were found in 3-year OS and DFS between patients with and without recurrent laryngeal nerve LND in the entire cohort (OS: 57% vs 52%, P = 0.33; DFS: 47% vs 41%, P = 0.186), or the surgery group (n = 173, OS: 69% vs 58%, P = 0.43; DFS: 52% vs. 48%, P = 0.30) and the neoadjuvant chemoradiotherapy group (n = 139, OS: 44% vs 43%, P = 0.44; DFS: 39% vs 32%, P = 0.27). However, among patients with clinical positive recurrent laryngeal nerve lymph node involvement before treatment, there was significant OS and DFS differences between patients with and without recurrent laryngeal nerve LND (OS: 62% vs 33%, P = 0.029; DFS: 49% vs 26%, P = 0.031).ConclusionsRecurrent laryngeal nerve LND is not a significant prognostic factor in patients with oesophageal squamous cell carcinoma; however, it is associated with better outcomes in patients with pre-treatment radiological evidence of recurrent laryngeal nerve lymph node involvement.
| S-EPMC8860418 | biostudies-literature
Project description:BackgroundThe laryngeal mask airway (LMAⓇ) ProtectorTM (Teleflex Medical Co., Ireland) is the latest innovation in the second generation of LMA devices. One distinguishing feature of this device is its integrated, color-coded cuff pressure indicator (Cuff PilotTM technology) which enables continuous cuff pressure monitoring and allows adjustments when necessary; this ensures patient safety due to better monitoring.CaseWe report a case of postoperative unilateral hypoglossal nerve palsy after uncomplicated use of the LMA Protector. To the best of our knowledge, this could be the second reported case.ConclusionsThis case demonstrates that anesthetists need to routinely measure cuff pressure and that the Cuff PilotTM technology is not a panacea for potential cranial nerve injury after airway manipulation.
| S-EPMC6900420 | biostudies-literature
Project description:The laryngeal adductor reflex (LAR) is a life-sustaining airway protective mechanism that serves to shield the lower airways from inhaled foreign bodies. Over the past half century, the LAR has been extensively investigated and its dysfunction has been linked to far-ranging pathologies, from dysphagia to sudden infant death syndrome. Over the past 6 years, specific electromyographic waves in the LAR response have been used to devise a methodology for monitoring the vagus and recurrently laryngeal nerves during surgical procedures. This methodology involves continuous intraoperative neuromonitoring of the laryngeal adductor reflex and isthus termed 'LAR-CIONM'. In this review paper, the physiology of the LAR will be summarized as it relates to LAR-CIONM and the technique of LAR-CIONM will be described. Applications of this technique and published outcomes of LAR-CIONM will be highlighted.
| S-EPMC9742263 | biostudies-literature